| Pai Participant 5 Pc | |
|
1526 Lombard St Philadelphia PA 19146-1625 | |
| (215) 546-5960 | |
| (215) 732-7450 |
| Full Name | Pai Participant 5 Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1526 Lombard St, Philadelphia, Pennsylvania |
| Authorized Official Name and Position | Erin N Laird (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 4104588713 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pai Participant 5 Pc Po Box 639676 Cincinnati OH 45263-9676 Ph: (859) 291-4800 | Pai Participant 5 Pc 1526 Lombard St Philadelphia PA 19146-1625 Ph: (215) 546-5960 |
| NPI Number | 1194381947 |
|---|---|
| Provider Enumeration Date | 05/17/2019 |
| Last Update Date | 08/10/2020 |
| Medicare PECOS PAC ID | 8325372881 |
|---|---|
| Medicare Enrollment ID | O20190703000887 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194381947 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Gary B Bernett |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1548204985 PECOS PAC ID: 4486559341 Enrollment ID: I20031204000023 |
| Provider Name | Susan Meller |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538177316 PECOS PAC ID: 1052463569 Enrollment ID: I20090714000755 |
| Provider Name | Mehrukh Mujeeb |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225232804 PECOS PAC ID: 3678741196 Enrollment ID: I20130617000531 |
| Provider Name | Thaddeus M Aversa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1417915968 PECOS PAC ID: 4284680604 Enrollment ID: I20130716000615 |
| Provider Name | Dennie Bryant |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1700174166 PECOS PAC ID: 2062631450 Enrollment ID: I20151015000828 |
| Provider Name | Ana Gomes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750348900 PECOS PAC ID: 7012963432 Enrollment ID: I20151110001069 |
| Provider Name | Mary Theresa Hoang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306015227 PECOS PAC ID: 5698848174 Enrollment ID: I20181004000963 |
| Provider Name | Zahra Shariff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538260492 PECOS PAC ID: 8527084128 Enrollment ID: I20181012000129 |
| Provider Name | Hima Parchuri |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386843332 PECOS PAC ID: 9638363542 Enrollment ID: I20200411000677 |
| Provider Name | Grace Iyabo Komolafe |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053790816 PECOS PAC ID: 6800140450 Enrollment ID: I20210913000028 |
| Provider Name | Obuchukwuneme Calais |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457829640 PECOS PAC ID: 3375880495 Enrollment ID: I20221006002753 |
| Provider Name | Bridget Ross-fitzgibbons |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144688102 PECOS PAC ID: 2961782826 Enrollment ID: I20221115000278 |
| Provider Name | Zaid Qaraghan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144634809 PECOS PAC ID: 3577782093 Enrollment ID: I20221206000120 |
| Provider Name | Michelle Moore |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215581970 PECOS PAC ID: 6204268147 Enrollment ID: I20230406002671 |
| Provider Name | Jill Butler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295706158 PECOS PAC ID: 3274500491 Enrollment ID: I20230602002462 |
| Provider Name | Akosua Neferteti Obeng-aduasare |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598311896 PECOS PAC ID: 7911238571 Enrollment ID: I20230725004046 |
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